ACE-INHIBITOR USE IS ASSOCIATED WITH HOSPITALIZATION FOR SEVERE HYPOGLYCEMIA IN PATIENTS WITH DIABETES

OBJECTIVE - To evaluate the association between the use of ACE inhibit ors and hospital admission for severe hypoglycemia and to explore the effects of potential confounding variables on this relationship. RESEA RCH DESIGN AND METHODS - The association between the use of ACE inhibi tors and the incidence of hypoglycemia is controversial. A recent stud y reported that 14% of all hospital admissions for hypoglycemia might be attributable to ACE inhibitors. We performed a nested case-control study using a cohort of 6,649 diabetic patients taking insulin or oral antidiabetic drugs, on the Diabetes Audit and Research in Tayside, Sc otland (DARTS) database. From 1 January 1993 to 30 April 1994, we iden tified 64 patients who had been admitted to Tayside hospitals with hyp oglycemia and selected 440 control patients from the same cohort. RESU LTS - Hypoglycemia was associated with the use of ACE inhibitors (odds ratio [OR] 3.2, 95% CI 1.2-8.3, P = 0.023), whereas use of beta-block ers and calcium antagonists was not associated with an increased risk of hospitalization for hypoglycemia with ORs of 0.9 (95% CI 0.3-3.3) a nd 1.7 (95% CI 0.2-2.1), respectively. There were significant differen ces between case and control patients in type of diabetes treatment, d iabetes duration, place of routine diabetes care, and congestive cardi ac failure. These differences did not confound the relationship betwee n ACE inhibitors and hypoglycemia (adjusted OR 4.3, 95% CI 1.2-1.0). C ONCLUSIONS - The results show that the association between ACE inhibit or therapy and hospital admission for severe hypoglycemia is not expla ined by these confounding factors. Although ACE inhibitors have distin ct advantages over other antihypertensive drugs in diabetes, the risk of hypoglycemia should be considered.